OPM Sets Requirements for FEHB Plans in 2023 – FEDweek

OPM has told FEHB carriers to continue with increased levels of telehealth and other services related to the pandemic in the 2023 plan year, while also either ordering or encouraging them to expand benefits for certain other conditions.

The annual “call letter” begins the negotiation process between OPM and health insurance companies that ends with announcements of new plan rates and terms in the fall, with a late-year open season for eligible persons to elect coverage for the following year.

“Telehealth services have rapidly expanded during the COVID-19 pandemic. In general, they have been met with broad acceptance from both providers and patients. OPM believes that telehealth continues to have an important role in the provision of healthcare services,” it said. “The expansion of remote monitoring capabilities can also improve the quality of care for those with chronic diseases.”

OPM said it strongly encourages” carriers “to continue supporting the efforts of providers to furnish telehealth services, including by continuing reasonable agreements on reimbursement.”

It also cited the “increasing incidences of mental health and substance use disorders throughout the COVID-19 pandemic . . . To address these concerns, FEHB carriers should intensify their focus on providing comprehensive mental health and substance use disorder benefits including ensuring parity with medical and surgical benefits,” it said.

OPM added that policies issued over the last two years arising from the pandemic remain in effect, including required coverage over-the-counter tests, booster doses, therapeutics, and pharmacy access to therapeutics. “In addition to providing such coverage, we encourage FEHB Carriers to continue initiatives put into place during the pandemic related to telehealth as well as mental health and substance use disorder services,” it said.

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